Beginning May 1, 2023, professional providers will be required to validate their Highmark Provider Directory information within the new Provider Data Maintenance (PDM) tool in NaviNet® every 90 days. They will no longer receive calls from Atlas or use PRIME, Atlas’ provider data management software, to update information.
The PDM tool will streamline the validation process by providing an easy-to-use electronic application to update, validate, and attest to the accuracy of your directory information in one electronic application. PDM also indicates the last time your directory information was validated and the due date for the next validation deadline.
EXCEPTION: Facility, ancillary, and any Medicaid providers will continue to use Atlas to validate their information as they do today.
Updates That Can Be Completed in PDM Versus PFM
PDM will be rolled out in phases necessitating certain changes continue to be made through Provider File Management (PFM). The table below outlines which PDM functionality will be available in May 2023. Most updates will be reflected in real-time; those that will pend for review are indicated with an asterisk (*).
Professional providers will be able to navigate between both the PFM and the PDM tools simultaneously in two separate tabs while using NaviNet. If a change is made to either PFM or PDM, providers must refresh the other tab being used to see the reflected changes.
|Update in PDM Tool
||Update in PFM Tool
- Office Information: address*, appointment phone number(s), email, website, handicap accessibility
- Group/Practitioner Information: practitioner name*, languages spoken, acceptance of new patients, practitioner specialty/role*, locations, affiliated networks, NPI, education, and adding and deleting of practitioners
- Patient Age Ranges
- Hospital Affiliations*
- Walk-ins Welcome
- Telehealth Services
- ePrescribe and Electronic Medical Records
- Identification of provider benefit level – Standard or Enhanced (view only)
- Credentialing status (view only), requests, changes, review of submitted changes (view only), and services
- Accreditation requests, changes, and review of changes
- Tax identification number (view only)
- Practitioner medical license number submissions or changes
- List of terminated addresses (view only)
- Services offered at current location
- Adding or deleting an address
Tips for Using the PDM Validation Function
This section includes tips for using the PDM validation function within NaviNet; it is not a full guide. A guide on how to use this function is being created and will be posted on Plan Central once complete.
IMPORTANT: Office staff workers who maintain the attestation data/information will need to have their NaviNet Security Officer grant them access to NaviNet to complete all future attestations.
It is recommended that you begin the validation process at least 1–2 weeks prior to your unique validation due date, as you will not be able to validate your information until all pending requests are completed (see #4: Editing Information below).
- Reviewing Last Validation Date:
Confirming the Information Is Valid:
- The top of the form will state the last date the provider validated their information and the next due date to validate their information.
Reviewing More Information:
- In each section, you must either select YES that information is valid or NO and then update with the correct information.
- If NO is selected:
- A message to use the edit function to update the information will pop up. Once the information is updated, unless it goes to the pending queue (see #4 below), go back, and select YES.
- If YES is not selected, the Validate button will be greyed out and not clickable.
- To review more information or edit information in any of the sections, click the ellipsis at the left of the options.
- If a professional provider needs to make edits while reviewing more information, click the edit button on the review screen. NOTE: The edit button and review screen will state the specific information that can be edited and will look different depending on what section of the form the professional provider is working on.
- Some information will pend for Highmark’s review after you submit your edits. You will be able to check all pending requests in the Pending Queue by clicking the Pending Request link at the top of the form. Changes that will need to pend for Highmark review include practitioner name, specialty and role, hospital affiliations, and addresses — if updates are for out of state or out of region.
- To access information about each individual practitioner, professional providers will need to click on the ellipsis next to each practitioner separately. Once you click the ellipsis, you will be taken to a new page with information about the individual practitioner’s specialty, whether the provider is accepting new patients, what languages the provider speaks, and other helpful information.
Provider News, Issue 3, March 2023 | © 2023 Highmark Blue Shield